This story is from the Anamnesis episode called Got Your Back and starts at 3:07 on the podcast. "Rambling Resident," the story teller here, is an internal medicine resident at a large, suburban Southern hospital. She did not want her real name used.
My surgery rotation was the last place I was expecting to make a friend. I figured I would always be in the OR or interacting with mostly sedated people, so it was a little surprising.
I'm a pretty friendly, extroverted person, so I guess in that sense it's not very surprising I was able to make friends, but this was how I got to know Mr. H.
Mr. H was a young-looking guy in his 40's. It was a little unusual to see a younger guy in the VA hospital, but I guess he had just spent some time in the military straight from high school. He was coming in with an incision and drainage of this horrible cellulitis on his foot.
Every morning, the other medical student and I went into his room, unwrapped his wounds to take a look, and present whatever we saw to the rest of the team, and then we would rewrap his wound. But even the slightest touch of the skin and this guy would just go screaming in pain. To me, being a very new medical student, this was very distressing. I had never seen anyone in that much pain before and so consistently in that much pain.
Patient Jekyll
One morning I just instinctively went to hold on to his hand as his dressings were changed, and he squeezed pretty tightly back, and later on the day when we went to check on him, he thanked me for holding his hand and he said he was thankful and grateful for my empathy.
His words made me feel very full and warm and I felt like I was finally fulfilling my mission going into medical school and going into the medical profession because I was actually helping someone. Especially on the surgery rotation, I just kind of felt like an extra body on the team, not really contributing much in the OR, and didn't have the medical knowledge quite yet.
This is where his gratefulness and his gratitude just spoke to me and touched me as well. I was also not really good at the exams in med school, so I was really expecting to be better at medical school rotations and being more productive, and I felt like this was the time for me to shine and show my true colors. That's why his words gave me a real sense of purpose and meaning.
My fellow med student and I would go back in the afternoons, and check in on him and his pain every afternoon as expected. He began to tell us his story and that's how we got to know a little bit more about him. He had an estranged adult daughter and he was telling us about how he was starting to have more of a relationship with her. She was his inspiration to be a better person and gave him life and energy to move forward. He lived at home with his elderly mother and his girlfriend. I guess together the two of them had looked after his mother, who apparently had her own set of health issues.
I felt like that's something we had in common, a value for family, and I respected that about him. I one day also thought that I would be looking after my parents, having them live with me as well. I felt very connected to him in that way.
Then, he opened up to us even more about how he was an IV drug user. He was addicted to heroin and that made sense to me because we were giving him small doses of oxycodone. But I guess, for him, someone who is chronically an opioid user, that was more like a sugar pill for him.
The Oxy didn't even touch his pain the slightest bit, no noticeable relief, and the surgeons were the ones prescribing these medications for him, so it made sense he sort of viewed them as the bad guys and us, the medical students, as the good guys. In the end, the surgeons were the ones who were really saving his life with the debridements and antibiotic treatments and source control.
He also told us how he blamed the ED docs for his opioid addiction. Apparently, he used to work as a handyman and a few years ago he had come to the ED after falling off a ladder. They sent him home with an absurd number of Percocet. This is how his opioid addiction began.
It made sense to me, but did I actually believe him? I wasn't sure at that point whether or not I could really believe him, but it seemed like a likely story. There's all this news about dentists and ED physicians overprescribing opioids, so it was possible is what I was thinking.
I thought it was a little unfair he kept blaming the people who were trying to help him, but he was really the one person on the whole team who made me feel like a useful, productive individual, and so I didn't really feel like thinking of him as a bad guy or antagonizing him. Also, he was just telling us and reassuring us he was getting off of IV drugs and trying to become a better person. I thought, "At least he's trying to take control of his own health."
On top of everything, he was a really nice guy -- very charismatic. He knew how to give out the right number of compliments, and my classmate and I, we just ate them up because we were looking for some sort of feedback or validation, especially on the surgery rotation where we felt like we were invisible.
Apparently, at one point, there were some quality improvement people going around the hospital asking patients who they recommended as stars on their team, and he told us he nominated us, so that also made us feel really good. Of course, the residents, they rolled their eyes when they heard it.
The rest of the surgery team hated him. Mr. H was the annoying, token opioid addict patient who was super hard to control his pain, and we couldn't really figure out how to control his pain or whether his pain was even real or if he was drug-seeking.
But at that point, I trusted him. I thought he was honest. He just seemed so genuine. In that environment, we were his only friends and he was our only friend. We really tried to promote him to the rest of the team and the residents and explain to them he's not a bad guy. He really has these pain issues and it makes sense why the Oxy isn't touching him. We advocated for him as much as we could.
Mr. Hyde
Then a few days into his hospital course, we started to notice he really was getting sleepier when we would go and talk to him in the afternoons to chat like we usually did. We started hearing reports from the nurses he would just leave his room and wheel himself off the unit to go and smoke. In the mornings, he wasn't screaming in pain as much. He was noticeably drowsier, and finally, we learned he had been leaving his room, we suspected, to maybe get heroin off the streets. He did have really good IV access and it wasn't an unusual situation in the VA as well for this type of thing to happen.
We couldn't ever prove this was what was going on. We never found illicit substances in his belongings or anything like that, but the nursing staff restricted his ability to leave the floor, and suddenly this man just turned from day to night.
Everything just made a little more sense at this point. He wasn't a smooth-talking guy anymore. He wasn't charismatic. He transformed into a very irritable, argumentative, almost monster-like at this point. Everything we thought we knew about him we started to feel was a lie of some sort.
My image of him just shattered. We started to realize his daughter, who he's supposedly having this growing bond with, wasn't coming to the hospital. His girlfriend was never around. His mother wasn't coming to visit. Nobody was coming to visit, and all of a sudden his niceness and his politeness started to get a little creepy.
He started to comment on our appearances. We started to wonder, "Was he really taking care of his mother at home? Was she actually taking care of him? Was he living with her rather than her living with him?" The social worker started to get more information about him being on probation for drug use and not having good compliance.
We could never prove he was going off into the streets to go get heroin, but we were pretty confident the sudden change in personality was attributed to something like this.
I, for one, didn't really feel like having conversations with him anymore. I didn't feel comfortable around him. I really felt betrayed, actually. I had trusted him and his stories. I thought I was just helping him by being friendly, being myself, fulfilling my mission, and listening to him.
Grain of Salt for 'Fresh Meat'
This whole situation and experience made me feel used, like he was manipulating us and taking advantage of our naivety, like we were just fresh meat. This was a huge setback for me. I felt so dumb and I felt like I was letting my insecurities lead me to be so gullible and blind.
When I think about this story, I'm not really sure how much of anything he said was real or not. Maybe it was the uncontrolled pain and the setting of opioid tolerance that made him desperate, or maybe I was just too harsh at the end, and my criticism was too harsh just like my first impression was a little too naïve in the beginning.
Maybe there is actually some sort of middle ground here I wasn't recognizing, but I felt like there was no doubt he was definitely taking advantage of me and my fellow med student, at least to some extent, and painting a better picture of himself than the reality.
Hopefully, maybe we still helped him a little bit by listening to him. But for me, this whole experience was extremely jarring and taught me an early lesson in cynicism.
Throughout the years, as my medical knowledge increased, I learned I actually have other ways I can help people through medicine in addition to being myself. But from then on, I always was a little bit more careful in terms of how much I actually believed what patients were telling me, and add a grain of salt.
Other stories from the Got Your Back episode: From Paralysis to Pen Pal and Over Her Dead Body
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